1
|
Vrdoljak DV, Ramljak V, Muzina D, Sarceviç B, Knezević F, Juzbasić S. Analysis of Metastatic Involvement of Interpectoral (Rotter's) Lymph Nodes Related to Tumor Location, Size, Grade and Hormone Receptor Status in Breast Cancer. TUMORI JOURNAL 2019; 91:177-81. [PMID: 15948548 DOI: 10.1177/030089160509100214] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background This study was aimed at analyzing metastatic involvement in interpectoral (Rotter's) lymph nodes in relation to tumor location, size, grade and hormone receptor status in primary breast cancer. Methods The study included 172 female patients undergoing surgery for breast cancer at the University Hospital for Tumors, Zagreb, Croatia from November 2001 to August 2003. In addition to the standard surgical procedure, interpectoral (Rotter's) lymph nodes were removed in all of the patients. Serum levels of the tumor marker CA 15-3 were determined before surgery and hormone receptor status after surgery. Results Rotter's lymph nodes were identified in 67% of the patients, with metastatic involvement being found in 20% of the Rotter's nodes. Metastatic involvement of Rotter's nodes in patients with negative and positive axillary lymph nodes was 4% and 35%, respectively. When we looked at the location of the tumor in patients with metastatic involvement of Rotter's nodes, we found that tumors located in the upper quadrants were more prone to metastasis to Rotter's nodes; there was a significant positive correlation between tumor location and positive Rotter's nodes (r = 0.953, P = 0.012). As regards tumor size, Rotter's nodes were identified in 15%, 20% and 30% of stage T1 (<2 cm), T2 (2-5 cm) and T3 (>5 cm) tumors, respectively. Hormone receptor status showed no statistically significant difference in the expression of estrogen and progesterone receptors between patients with and those without positive Rotter's nodes. Of 35 Rotter's node-positive patients, 31.4% had elevated serum levels of CA 15-3; the level was significantly higher in Rotter's-positive patients compared to those with negative (or absent) Rotter's nodes. Conclusions The results show that one-fifth of breast cancer patients, or even one-third of those with positive axillary lymph nodes, are discharged with positive interpectoral lymph nodes that remain undiagnosed. As the nodes can be surgically removed without additional mutilation, exploration of Rotter's lymph nodes should be introduced into routine clinical practice.
Collapse
|
2
|
Han C, Yang B, Zuo WS, Liu YS, Zheng G, Yang L, Zheng MZ. Prospective study found that peripheral lymph node sampling reduced the false-negative rate of sentinel lymph node biopsy for breast cancer. CHINESE JOURNAL OF CANCER 2016; 35:35. [PMID: 27044285 PMCID: PMC4820923 DOI: 10.1186/s40880-016-0099-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/03/2016] [Indexed: 02/06/2023]
Abstract
Background Although sentinel lymph node biopsy (SLNB) can accurately predict the status of axillary lymph node (ALN) metastasis, the high false-negative rate (FNR) of SLNB is still the main obstacle for the treatment of patients who receive SLNB instead of ALN dissection (ALND). The purpose of this study was to evaluate the clinical significance of SLNB combined with peripheral lymph node (PLN) sampling for reducing the FNR for breast cancer and to discuss the effect of “skip metastasis” on the FNR of SLNB. Methods At Shandong Cancer Hospital Affiliated to Shandong University between March 1, 2012 and June 30, 2015, the sentinel lymph nodes (SLNs) of 596 patients with breast cancer were examined using radiocolloids with blue dye tracer. First, the SLNs were removed; then, the area surrounding the original SLNs was selected, and the visible lymph nodes in a field of 3–5 cm in diameter around the center (i.e., PLNs) were removed, avoiding damage to the structure of the breast. Finally, ALND was performed. The SLNs, PLNs, and remaining ALNs underwent pathologic examination, and the relationship between them was analyzed. Results The identification rate of SLNs in the 596 patients was 95.1% (567/596); the metastasis rate of ALNs was 33.7% (191/567); the FNR of pure SLNB was 9.9% (19/191); and after the SLNs and PLNs were eliminated, the FNR was 4.2% (8/191), which was significantly decreased compared with the FNR before removal of PLNs (P = 0.028). According to the detected number (N) of SLNs, the patients were divided into four groups of N = 1, 2, 3, and ≥4; the FNR in these groups was 19.6, 9.8, 7.3, and 2.3%, respectively. For the patients with ≤2 or ≤3 detected SLNs, the FNR after removal of PLNs was significantly decreased compared with that before removal of PLNs (N ≤ 2: 14.0% vs. 4.7%, P = 0.019; N ≤ 3: 12.2% vs. 4.7%, P = 0.021), whereas for patients with ≥4 detected SLNs, the decrease in FNR was not statistically significant (P = 1.000). In the entire cohorts, the “skip metastasis” rate was 2.5% (15/596); the FNR caused by “skip metastasis” was 2.1% (4/191). Conclusions The FNR of SLNB was associated with the number of SLNs. For patients with ≤3 detected SLNs, PLN sampling can reduce the FNR of SLNB to an acceptable level of less than 5%. Because of the existence of the “skip metastasis” and distinct metastasis patterns, the FNR of SLNB cannot be completely eliminated.
Collapse
Affiliation(s)
- Chao Han
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, 250022, Shandong, P.R. China.,Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, P.R. China
| | - Ben Yang
- Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, P.R. China
| | - Wen-Shu Zuo
- Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, P.R. China.
| | - Yan-Song Liu
- Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, P.R. China
| | - Gang Zheng
- Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, P.R. China
| | - Li Yang
- Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, P.R. China
| | - Mei-Zhu Zheng
- Department of Surgery, Shandong Breast Center of Prevention and Treatment, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, P.R. China
| |
Collapse
|
3
|
Bricou A, Delpech Y, Barranger E. [Is there an interest in the exploration of the interpectoral space (Rotter's nodes) in the surgical management of the breast cancer?]. ACTA ACUST UNITED AC 2010; 38:92-4. [PMID: 20089434 DOI: 10.1016/j.gyobfe.2009.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- A Bricou
- Service de gynécologie-obstétrique, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
| | | | | |
Collapse
|
5
|
van Rijk MC, Tanis PJ, Nieweg OE, Loo CE, Olmos RAV, Oldenburg HSA, Rutgers EJT, Hoefnagel CA, Kroon BBR. Sentinel Node Biopsy and Concomitant Probe-Guided Tumor Excision of Nonpalpable Breast Cancer. Ann Surg Oncol 2006; 14:627-32. [PMID: 17151797 DOI: 10.1245/s10434-006-9070-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Revised: 06/27/2006] [Accepted: 06/28/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Preliminary data have shown encouraging results of a single intratumoral radiopharmaceutical injection that enables both sentinel node biopsy and probe-guided excision of the primary tumor in patients with nonpalpable breast cancer. The aim of the study was to evaluate this approach in a large group of patients. METHODS Lymphoscintigraphy was performed in 368 patients with nonpalpable breast cancer after intratumoral injection of (99m)Tc-nanocolloid (.2 mL, 123 MBq, 3.3 mCi) guided by ultrasound or stereotaxis. The sentinel node was pursued with the aid of vital blue dye (1.0 mL, intratumoral) and a gamma ray detection probe. In case of breast-conserving surgery, the probe was used to guide the excision. RESULTS At least one sentinel node could be identified intraoperatively in 357 patients (97%), of whom 69 had involved nodes (19%). Age over 60 years was associated with less frequent nonaxillary lymphatic drainage and absence of internal mammary chain dissemination. Tumor-free margins were obtained in 262 (89%) of the 293 patients who underwent segmental excision. Re-excision of the primary tumor bed was performed in six patients (2%). During a median follow-up of 22 months, one breast recurrence and one axillary recurrence were observed. CONCLUSIONS Lymphatic mapping and probe-guided tumor excision of nonpalpable breast cancer by intralesional administration of a single dose of (99m)Tc-nanocolloid and blue dye resulted in 97% identification of the sentinel node and in tumor-free margins in 89% of the patients who underwent breast-conserving surgery. Longer follow-up is needed to substantiate the accuracy and safety of this technique.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Female
- Humans
- Lymphatic Metastasis
- Mastectomy/instrumentation
- Middle Aged
- Neoplasm Staging
- Radionuclide Imaging
- Radiopharmaceuticals
- Sentinel Lymph Node Biopsy/methods
- Technetium Tc 99m Aggregated Albumin
Collapse
Affiliation(s)
- Maartje C van Rijk
- Department of Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
van Rijk MC, Tanis PJ, Nieweg OE, Olmos RAV, Rutgers EJT, Hoefnagel CA, Kroon BBR. Clinical implications of sentinel nodes outside the axilla and internal mammary chain in patients with breast cancer. J Surg Oncol 2006; 94:281-6. [PMID: 16917875 DOI: 10.1002/jso.20574] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The aim of this study was to determine the incidence, location, surgical identification rate, tumor status, and clinical implications of sentinel nodes outside the axilla and internal mammary chain. PATIENTS AND METHODS In 785 breast cancer patients, pre-operative lymphoscintigraphy was performed after intratumoral injection of 116 MBq 99mTc-labeled nanocolloid (0.2 ml; 3.1 mCi). Sentinel nodes were pursued using a gamma-ray detection probe and vital blue dye. RESULTS Lymphoscintigraphy visualized sentinel nodes outside the axilla and internal mammary chain in 91 of the 785 patients (12%). Sentinel nodes (106) were identified in 80 patients. These nodes were found in the following locations: 50 in the breast, 31 in the infraclavicular fossa, 19 between the pectoral muscles, and 6 within the supraclavicular bed. Eighteen nodes contained a metastasis (17%) and were removed from 16 patients. The treatment strategy was adjusted in 12 of them with the addition of adjuvant local or systemic therapy. Two additional patients with an unusually situated tumor-negative sentinel node were spared an axillary node dissection that would otherwise have been performed. CONCLUSION Unusually situated sentinel nodes were visualized in 12% of the patients. The treatment was adjusted in 18% of patients in whom these nodes were identified.
Collapse
Affiliation(s)
- Maartje C van Rijk
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
7
|
García-Vilanova Comas A, García Vilanova A, Fuster-Diana E, Martínez-Alzamora N, Fernández-Tena J, García-Vilanova Comas J, García-Vilanova Comas M. Prognostic value of the interpectoral lymph nodes in breast cancer: A 20-year survival study. Clin Transl Oncol 2006; 8:108-18. [PMID: 16632425 DOI: 10.1007/s12094-006-0167-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The indication and extent of axillary lymph node dissection in breast cancer remains open to controversy. MATERIALS AND METHOD In this context, a 20-year survival study has been made of 1600 breast cancer patients subjected during surgical treatment to systematic dissection of the acromiothoracic vascular pedicle together with the accompanying lymph nodes (Rotter and Grossman interpectoral lymph node groups). An anatomical study of these nodes was also conducted in 100 necropsies, with the evaluation of 200 acromiothoracic vascular pedicles. RESULTS The interpectoral lymph nodes were anatomically present in 42% of the necropsies and in 35.1% of the patients subjected to surgery. The prognosis was much worse in cases of neoplastic infiltration of the interpectoral lymph nodes (Kaplan-Meier survival study), regardless of the influence of other prognostic factors. CONCLUSIONS In view of the results obtained, the designation of grade N3 of the TNM classification is proposed for malignancies with positive interpectoral lymph node infiltration.
Collapse
|
8
|
Hong J, Choy E, Chog E, Soni N, Carmalt H, Gillett D, Spillane AJ. Extra-axillary sentinel node biopsy in the management of early breast cancer. Eur J Surg Oncol 2005; 31:942-8. [PMID: 16229984 DOI: 10.1016/j.ejso.2005.08.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Accepted: 08/04/2005] [Indexed: 11/23/2022] Open
Abstract
AIM To document of our experience with EAS SNB and evaluate its impact on the staging, management and the associated morbidities of patients with early breast cancer. METHOD A review of two prospective breast cancer databases identifying all SNB procedures performed at two affiliated breast units from 1998 to 2003. RESULTS A series of 979 patients underwent lymphatic mapping. Sentinel nodes were successfully identified in 903 patients. There were 142 cases in which lymphoscintigraphy identified EAS. In 17 cases extraaxillary sentinel nodes were identified with lymphoscintigraphy but could not be removed. There were 138 cases where internal mammary nodes (IMN) were removed. Of those IMN removed 25 were positive for metastases and in six of these cases only the IMN was positive. Of the 21 cases where other EAS were identified there was one case in which a supraclavicular sentinel node was positive. Twenty-five of the 26 positive sentinel nodes in EAS were macrometastases and one was a micrometastasis. No significant morbidity resulted from biopsy of EAS SNB. During IMN SNB there were eight pleural breeches, which did not result in pneumothoraces, and one case in which bleeding was difficult to control. CONCLUSION EAS SNB is technically feasible in the majority of cases. Minimal morbidity occurs after an initial learning phase. IMN SNB was shown to have significant impact on the staging and management in 18% of patients when IMNs were identified with lymphoscintigraphy. The impact of other extraaxillary lymph nodes is more difficult to assess due to small numbers. As there is little morbidity and valuable information is gained in a significant percentage of cases we strongly advocate EAS SNB.
Collapse
Affiliation(s)
- J Hong
- Sydney Cancer Centre, Breast Unit, Royal Prince Hospital, Sydney, NSW, Australia
| | | | | | | | | | | | | |
Collapse
|